Postural Changes in Measures of Arterial Stiffness in Hypertensive Subjects on Antihypertensive Drug Therapy: A Prospective, Pilot Study

Abstract

Prospective study with a controlled arm to know if there are variations of measures of arterial stiffness with posture in subjects with hypertension on antihypertensive medications.

We studied postural variations of measures of arterial stiffness in 21 subjects with diagnosed hypertension on antihypertensive medications and compared them with 21 normotensive subjects. All subjects underwent pulse-wave analysis on SphygmoCor in the morning between 8 am to 10 am initially in supine and then in sitting position after 3 minutes. Summary measures on demographics, and blood pressure characteristics at sitting and supine positions are obtained. Differences between characteristics at supine and sitting position are compared using nonparametric paired test of Wilcoxon signed-rank test. A value of p < 0.05 was accepted as statistically significant.

Antihypertensive medications decreased the supine aortic augmentation pressure (AAP) and augmentation index (AI) but not significantly. When subgroups of patients with antihypertensive treatment were analyzed, it was noted that angiotensin-converting enzyme inhibitor and angiotensin receptor blocker group (12) decreased AAP and AI significantly in supine position compared with patients on other antihypertensive medications (9) (p-value 0.034 and 0.038, respectively). There was no significant difference in other groups of calcium channel blockers, β-blockers, or diuretics. However, in normotensive control arm, there was an increase in AAP and AI in the supine position.

In hypertensive subjects, on antihypertensive, there was reduction in AAP and AI in supine position compared with those of normotensives. The significance of the decrease in AAP and AI in supine position on antihypertensive needs to be studied further.

Keywords

hypertension - young - posture - arterial stiffness

• References

• 1 Hasegawa M, Rodbard S. Effect of posture on arterial pressures, timing of the arterial sounds and pulse wave velocities in the extremities. Cardiology 1979; 64 (2) 122-132
• 2 Vrachatis D, Papaioannou TG, Konstantopoulou A , et al. Effect of supine versus sitting position on noninvasive assessment of aortic pressure waveform: a randomized cross-over study. J Hum Hypertens 2014; 28 (4) 236-241
• 3 Jaccoud L, Rotaru C, Heim A , et al. Major impact of body position on arterial stiffness indices derived from radial applanation tonometry in pregnant and nonpregnant women. J Hypertens 2012; 30 (6) 1161-1168
• 4 Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000; 525 (Pt 1): 263-270
• 5 Verwoert GC, Elias-Smale SE, Rizopoulos D , et al. Does aortic stiffness improve the prediction of coronary heart disease in elderly? The Rotterdam Study. J Hum Hypertens 2012; 26 (1) 28-34
• 6 Sutton-Tyrrell K, Najjar SS, Boudreau RM , et al; Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005; 111 (25) 3384-3390
• 7 Chirinos JA, Zambrano JP, Chakko S , et al. Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension 2005; 45 (5) 980-985
• 8 Weber T, Auer J, O'Rourke MF , et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation 2004; 109 (2) 184-189
• 9 Laurent S, Katsahian S, Fassot C , et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003; 34 (5) 1203-1206
• 10 Boutouyrie P, Tropeano AI, Asmar R , et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002; 39 (1) 10-15
• 11 Safar ME, Blacher J, Pannier B , et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002; 39 (3) 735-738
• 12 Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol 2001; 21 (12) 2046-2050
• 13 Laurent S, Boutouyrie P, Asmar R , et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37 (5) 1236-1241
• 14 Roman MJ, Devereux RB, Kizer JR , et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 2007; 50 (1) 197-203
• 15 Mitchell GF, Hwang SJ, Vasan RS , et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010; 121 (4) 505-511
• 16 Dahlöf B, Sever PS, Poulter NR , et al; ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366 (9489): 895-906